Changes in End-Organ Function in Patients With Prolonged Continuous-Flow Left Ventricular Assist Device Support

• Published in: The Annals of thoracic surgery Vol. 103; no. 3; pp. 717 - 724
• Main Authors: Yoshioka, Daisuke, MD, Takayama, Hiroo, MD, PhD, Colombo, Paolo C., MD, Yuzefpolskaya, Melana, MD, Garan, Arthur R., MD, Topkara, Veli K., MD, Han, Jiho, BS, Kurlansky, Paul, MD, Naka, Yoshifumi, MD, PhD, Takeda, Koji, MD, PhD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01-03-2017
• Subjects: Aged; Cardiothoracic Surgery; Female; Heart Failure - complications; Heart Failure - physiopathology; Heart Failure - therapy; Heart-Assist Devices; Humans; Kidney - physiopathology; Liver - physiopathology; Male; Middle Aged; Retrospective Studies; Surgery; Time Factors; Treatment Outcome; Ventricular Function, Left - physiology
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2016.12.018

Background Few studies have evaluated the long-term effects of continuous blood flow with reduced pulsatility on end-organ function. Methods Between May 2004 and December 2015, 469 patients underwent continuous-flow left ventricular assist device (LVAD) implantation at our center. Our study included 59 (13%) patients who were supported with an LVAD for a minimum of 3 years. We evaluated postoperative renal function and hepatic function at 1 and 6 months, and 1, 2, and 3 years after implantation in those 59 patients. Results The patients’ mean age was 63 ± 13 years, 81% were male, 53% had an ischemic cause of heart failure, and 68% underwent LVAD implantation as destination therapy. All laboratory determinations showed significant improvements at 1 month after the procedure. Hepatic values remained in a normal range for up to 3 years, although renal function improvement was predominantly transient. One month after implantation, the mean estimated glomerular filtration rate (eGFR) was improved from 58.2 ± 27.9 to 77.7 ± 33.5 mL/min/1.73 m2 . However, 46 (78%) patients showed a gradual decline in eGFR to only 1.7% above the preoperative value after 3 years ( p  = 0.67 vs baseline). The risk factors for impaired renal function after long-term support were age 60 years or older, ischemic cause, and late right heart failure. Conclusions Continuous-flow LVAD improves renal and hepatic functions in patients with advanced heart failure. However, in most, the initial improvement in renal function is largely transient and returns to baseline after a prolonged support period.